Approximately 60% to 80% of children are exposed to violence and about a third of those children are exposed to multiple victimization types (Finkelhor, et al., 2009a,b). There are many types of traumatic events associated with posttraumatic stress disorder (PTSD), such as personal assault, severe automobile accidents, sexual abuse, domestic violence, terrorist attacks, having a life-threatening illness, and witnessing or learning about serious injury or death. Given the prevalence of traumatic events among children, including young children (Finkelhor, et al., 2009a,b), there exists a need for accessible and cost effective approaches that can be easily applied to meet the therapeutic demands for treating PTSD. Stepped Care approaches maximize resources by providing lower intensity and less costly interventions as a first line treatment while stepping up care to address individualized patient needs for those who require more intensive treatment (Bower &Gilbody, 2005;Haaga, 2000). Stepped Care, as opposed to standard therapist-directed treatment where all patients receive the "full treatment package", is designed to increase access to effective mental health treatment. The purpose of the proposed application is to develop and test the feasibility of a novel Stepped Care Trauma Focused Cognitive Behavioral Therapy (TF-CBT) intervention for young children (ages 3 to 7) with clinically significant PTSD symptoms. Building upon existing scientific knowledge of evidence-based treatment for childhood PTSD, Stepped Care TF-CBT is designed to improve treatment access, be delivered with less therapist time, and reduce the cost of treatment for both patients and providers. In Stepped Care TF-CBT the caregiver administers the first step with minimal therapist assistance (three therapy sessions plus weekly telephone support, an empirically informed parent-child workbook, and web-based information). Only children who do not respond to step one will "step-up" to step two to receive more intensive individualized TF-CBT. This proposed project is comprised of two phases. Phase I consists of an open trial of Stepped Care TF-CBT to systematically gather feedback for the development and refinement of the Stepped Care TF-CBT protocol. Phase II consists of a small randomized clinical trial to conduct a preliminary comparison of Stepped Care TF-CBT to standard care TF-CBT. The primary aims of this application are: 1) to develop and test the feasibility of a Stepped Care TF-CBT protocol for treating PTSD in young children (Phase I);and 2) to conduct a small randomized controlled trial comparing Stepped Care TF-CBT versus standard TF-CBT for treating young children with PTSD (Phase II). Exploratory aims are: 3) to explore differential characteristics of children who respond at step one versus step two of Stepped Care TF-CBT (Phase II);and 4) to assess the preliminary costs of delivering Stepped Care TF-CBT versus the costs of delivering standard care TF-CBT (Phase I and II). The proposed new Stepped Care intervention has the potential to improve access to evidence-based treatment, thereby reducing childhood PTSD and related societal impacts and costs. PUBLIC HEALTH RELEVANCE: Young children who are exposed to traumatic events such as abuse, disasters, accidents, illnesses, injury and the death of a person close to them are at risk for developing PTSD. While effective treatments for childhood PTSD exist, novel interventions that are more accessible, efficient, and cost-effective are needed to improve access to evidence-based treatment. The proposed project develops and tests the feasibility of an intervention called Stepped Care Trauma-Focused Cognitive Behavioral Therapy which has the potential to greatly improve service delivery approaches to make treatment more accessible and less costly, thereby reducing childhood PTSD and related societal impacts and costs.